Croup

A barking cough and noisy breathing in a small child. Frightening to hear, and usually treated with one dose of steroid.

What it is

Croup is a viral infection causing swelling of the voice box and windpipe in young children, usually between six months and three years.

It produces a distinctive barking cough, often described as sounding like a seal, and stridor, a harsh noise on breathing in.

It is almost always viral and usually mild, and it characteristically gets worse at night, which is when most families end up frightened and phoning 111.

The treatment is a single dose of oral steroid, dexamethasone, which reduces the swelling and works well. Most children are then fine.

The distinction that matters is between croup and the rare but life-threatening causes of stridor: epiglottitis, a foreign body, or a severe allergic reaction.

Signs you might notice

A barking, seal-like cough.

Stridor: a harsh, rasping noise breathing in, worse when upset or crying.

A hoarse voice.

Symptoms worse at night and worse when distressed.

Red flags meaning something more serious: drooling and inability to swallow, sitting forward with the chin out, a very quiet child who has stopped fighting, pale or blue colour, severe chest indrawing, or a child who suddenly began choking.

How it can affect day-to-day life

Calm is genuinely therapeutic. Distress worsens stridor, and a crying child sounds far worse than a settled one, so keeping the child comfortable on a parent's lap is treatment rather than comfort.

Steam and cold air are traditional and neither has good evidence. Steam has caused scalds and is not recommended.

Recurrent croup, or croup outside the usual age range, warrants assessment for an underlying airway problem.

Supporting someone well

Stay calm and keep the child calm. Hold them upright on your lap. Do not lie them flat, and do not examine their throat.

Get a dose of dexamethasone. It is effective and one dose usually suffices.

Do not use steam.

Give paracetamol for fever and discomfort, and keep fluids going.

Know the red flags, especially drooling and the child who has gone quiet, which is more worrying than the one making noise.

Expect it to be worse at night for two or three nights.

Where to get help

Call 111 or a GP for a child with a barking cough and mild stridor.

Call 999 for drooling, inability to swallow, blue or pale colour, severe chest indrawing, or a child who is quiet, exhausted or unrousable.

Sudden onset with choking may be an inhaled foreign body and is an emergency.